“PAT? WHAT’S

THAT”JEREMY CHAPMAN DO

KPN HOSPITALIST

My Background

3 years ICU Nursing

1 year Med-Surg Nursing

Medical School: Ohio University Heritage

College of Osteopathic Medicine

Residency: Adena Regional Medical Center

Internal Medicine Program

KPN Hospitalist for 2 years

My Family

Objectives

By the end of this presentation you should be

able to…

1. Describe what PAT is

2. Basic understanding of what happens in PAT

3. Know when it is appropriate to use PAT

4. Understand the goal/purpose of PAT

5. Why a hospitalist is used rather than a PCP

What is PAT?

Pre-admission Testing

Not clearance!!!

Risk stratify

Looking at the whole picture

History

1980’s research showed no benefit and not cost effective

Over last 20 years, a push to be more selective

Surgeon: “are they cleared for surgery?”

Me:

What happens in PAT

Selective Testing

CBC

Renal Panel

A1c

UA

EKG

PCI?

Liver panel

CXR

PFT

Risk Calculators

Pretends to be a doctor on TV

and makes 10 times more

money than we do, THIS IS

NOT FAIR!

Risk factors for coronary

disease:

1.) Hypertension >140/90

2.) Serum LDL >159

3.) Serum HDL <40

4.) DM with A1c >6.9

5.) Smoking

When To Use PAT

What Is The Goal/Purpose

The long and short of it is use PAT when there is suspicion that the patient can be optimized prior to surgery

For different surgeries optimization means different things

NOT EVERY PERSON GOING FOR SURGERY NEEDS PAT

I NEED YOU TO

UNDERSTAD THIS

Why Hospitalists Rather Than PCP

Consistency of care

Decreased workload

Increase postoperative

follow-up

Improve communication

between PAT and

surgery

Because we are

younger and

cooler

All else fails, put them in quarantine

QUESTIONS? I am exhausted

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Lawrence VA, Gafni A, Gross M. The unproven utility of the preoperative urinalysis: economic evaluation. J Clin Epidemiol. 1989. 42(12):1185-92. [Medline].

Goldberger AL, O'Konski M. Utility of the routine electrocardiogram before surgery and on general hospital admission. Critical review and new guidelines. Ann Intern Med. 1986 Oct. 105(4):552-7. [Medline].

Noordzij PG, Boersma E, Bax JJ, et al. Prognostic value of routine preoperative electrocardiography in patients undergoing noncardiac surgery. Am J Cardiol. 2006 Apr 1. 97(7):1103-6. [Medline].

Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009 Jul 7. 120(1):86-95. [Medline].